MEDICARE: MR. NOAH JULIAN SIMCOX LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	13805	MN

General Provider Information

NPI Number	:	1134448590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NOAH JULIAN SIMCOX LICSW

Provider Business Mailing Address
First Line	:	3843 GLENHURST AVE
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-4915
Country	:	US
Telephone Number	:	651-646-2326
Fax Number	:

Provider Business Practice Location Address
First Line	:	4021 VERNON AVE S STE 306
Second Line	:
City	:	SAINT LOUIS PARK
State	:	MN
Zip	:	55416-2816
Country	:	US
Telephone Number	:	651-646-2326
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2010
Last Update Date	:	04/27/2022

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